The effect of social anxiety on threat acquisition and extinction: a systematic review and meta-analysis.

Although exposure-based therapy has been found to be effective at alleviating symptoms of social anxiety disorder, it often does not lead to full remission, and relapse after treatment is common. Exposure therapy is based on theoretical principles of extinction of conditioned fear responses. However, there are inconsistencies in findings across experiments that have investigated the effect of social anxiety on threat conditioning and extinction processes. This systematic review and meta-analysis aimed to examine whether elevated levels of social anxiety are associated with abnormalities in threat conditioning and extinction processes. A second aim was to examine the sensitivity of various study designs and characteristics to detect social anxiety-related differences in threat conditioning and extinction. A systematic search was conducted, which identified twenty-three experiments for inclusion in the review. The findings did not demonstrate compelling evidence that high levels of social anxiety are associated with atypical threat conditioning or extinction. Further, when systematically examining the data, there was no convincing support that the use of a particular psychophysiological measure, subjective rating, or experimental parameter yields more consistent associations between social anxiety and conditioning processes during threat acquisition or extinction. Meta-analyses demonstrated that during threat extinction, the use of anxiety ratings as a dependent variable, socially relevant unconditioned stimuli, and a higher reinforcement schedule produced more detectable effects of social anxiety on compromised extinction processes compared to any other dependent variable (subjective or physiological) or experimental parameter. Overall, the results of this study suggest that social anxiety is not reliably related to deficits in conditioning and extinction processes in the context of laboratory-based Pavlovian conditioning paradigms.

Therapeutic alliance in two forms of guided self-help for binge eating.

The role of therapeutic alliance within psychological treatments for eating disorders (EDs), including those delivered remotely, is well established. However, few studies have investigated alliance in guided self-help, a widely recommended first-line treatment for EDs characterised by regular binge eating. Using data from a randomised controlled trial, the current study examined both facilitator and patient assessments of alliance within e-mail-assisted and face-to-face guided self-help and looked at associations between alliance, ED symptoms and ED-related impairment. One hundred thirteen patients and 11 facilitators completed measures of alliance during and following a course of guided self-help. Whilst ratings were reliable across patients and facilitators, alliance scores were higher both in the patient sample and in the face-to-face condition. Ratings of alliance showed no correlations with ED symptoms at post-treatment, and early alliance was not significantly associated with outcome, which could inform how early symptom change is encouraged in guided self-help.

Just let me check: The role of individual differences in self-reported anxiety and obsessive-compulsive features on subjective, behavioural, and physiological indices during a checking task.

Checking behaviour has been described as a form of preventative behaviour used by an individual to establish control over the environment and avoid future misfortune. However, when compulsive, checking behaviours can become disabling and distressing and have been linked to the maintenance of anxiety and obsessive-compulsive disorders. Despite this, there is limited literature across the field that has assessed the impact of dimensional measures of anxiety and obsessive-compulsive features (i.e., negative affect, uncertainty, and perfectionism) in driving checking behaviour. As such, the present study examined the impact of individual differences in self-reported anxiety and obsessive-compulsive features on subjective, behavioural, and physiological indices during a visual discrimination and checking task (n = 87). Higher self-reported anxiety and obsessive-compulsive features were associated with higher subjective ratings of unpleasantness and the urge to check during the task. Moreover, higher self-reported anxiety and obsessive-compulsive features related to general negative affect, uncertainty, and perfectionism were associated with greater checking frequency during the task. Lastly, stronger obsessional beliefs about perfectionism and the need for certainty were found to predict poorer accuracy, slower reaction times, and higher engagement of the corrugator supercilii during the task. In sum, these findings demonstrate how different anxiety and obsessive-compulsive features, in particular perfectionism and the need for certainty, may relate to and maintain checking behaviour in low threat contexts, which likely has implications for models of excessive and persistent checking in anxiety and obsessive-compulsive disorders.

Intolerance of uncertainty and novelty facilitated extinction: The impact of reinforcement schedule.

Individuals who score high in intolerance of uncertainty (IU) display reduced threat extinction. Recently, it was shown that replacing threat associations with novel associations during extinction learning (i.e., presenting a novel tone 100% of the time) can promote threat extinction retention in individuals with high IU. This novelty facilitated extinction (NFE) effect could be driven by the tone's novelty or reliability. Here, we sought to address this question by adjusting the reliability of the novel tone (i.e., the reinforcement rate) during NFE. We measured skin conductance response during an associative learning task in which participants (n = 92) were assigned to one of three experimental groups: standard extinction, NFE 100% reinforcement, or NFE 50% reinforcement. For standard extinction, compared to NFE 100% and 50% reinforcement groups, we observed a trend for greater recovery of the conditioned response during extinction retention. Individuals with high IU relative to low IU in the standard extinction group demonstrated a larger recovery of the conditioned response during extinction retention. These findings tentatively suggest that NFE effects are driven by the novelty rather than the reliability of the new stimulus. The implications of these findings for translational and clinical research in anxiety disorder pathology are discussed.

Intolerance of uncertainty and physiological responses during instructed uncertain threat: A multi-lab investigation.

Individuals with high self-reported Intolerance of uncertainty (IU) tend to interpret uncertainty negatively. Recent research has been inconclusive on evidence of an association between IU and physiological responses during instructed uncertain threat. To address this gap, we conducted secondary analyses of IU and physiology data recorded during instructed uncertain threat tasks from two lab sites (Wisconsin-Madison; n = 128; Yale, n = 95). No IU-related effects were observed for orbicularis oculi activity (auditory startle-reflex). Higher IU was associated with: (1) greater corrugator supercilii activity to predictable and unpredictable threat of shock, compared to the safety from shock, and (2) poorer discriminatory skin conductance response between the unpredictable threat of shock, relative to the safety from shock. These findings suggest that IU-related biases may be captured differently depending on the physiological measure during instructed uncertain threat. Implications of these findings for neurobiological models of uncertainty and anticipation in anxiety are discussed.

The effect of social anxiety on the acquisition and extinction of low-cost avoidance.

Excessive avoidance and safety behaviours are a hallmark feature of social anxiety disorder. However, the conditioning and extinction of avoidance behaviour in social anxiety is understudied. Here, we examined the effect of individual differences in social anxiety on low-cost operant avoidance conditioning and extinction in 80 female participants. We employed an avoidance conditioning and extinction paradigm and measured skin conductance response, threat expectancy ratings and avoidance behaviour throughout the task. Findings demonstrated that elevated levels of social anxiety predicted the generalisation of conditioned avoidance responses across to safety cues during avoidance conditioning. When the opportunity to avoid was returned after the threat extinction phase, elevated social anxiety was associated with increased avoidance behaviour to threat cues. The results suggest that compromised extinction of avoidance behaviour is a characteristic of social anxiety and supports the strategy of minimising avoidance and safety behaviours during exposure therapy for the treatment of social anxiety disorder. Future research should utilise the avoidance conditioning and extinction paradigm as a laboratory model for clinical research to investigate how, and under what circumstances, the extinction of avoidance and safety behaviours can be improved for individuals high in social anxiety.

Intolerance of uncertainty, and not social anxiety, is associated with compromised extinction of social threat.

Extinction-resistant threat is regarded as a central hallmark of pathological anxiety. However, it remains relatively under-studied in social anxiety. Here we sought to determine whether self-reported trait social anxiety is associated with compromised threat extinction learning and retention. We tested this hypothesis within two separate, socially relevant conditioning studies. In the first experiment, a Selective Extinction Through Cognitive Evaluation (SECE) paradigm was used, which included a cognitive component during the extinction phase, while experiment 2 used a traditional threat extinction paradigm. Skin conductance responses and subjective ratings of anxiety (experiment 1 and 2) and expectancy (experiment 2) were collected across both experiments. The findings of both studies demonstrated no effect of social anxiety on extinction learning or retention. Instead, results from experiment 1 indicated that individual differences in Intolerance of Uncertainty (IU) were associated with the ability to use contextual cues to decrease a conditioned response during SECE. However, during extinction retention, high IU predicted greater generalisation across context cues. Findings of experiment 2 revealed that higher IU was associated with impaired extinction learning and retention. The results from both studies suggest that compromised threat extinction is likely to be a characteristic of high levels of IU and not social anxiety.

I Doubt It Is Safe: A Meta-analysis of Self-reported Intolerance of Uncertainty and Threat Extinction Training.

Background: Intolerance of uncertainty (IU), the tendency to find uncertainty distressing, is an important transdiagnostic dimension in mental health disorders. Higher self-reported IU has been linked to poorer threat extinction training (i.e., the updating of threat to safe associations), a key process that is targeted in exposure-based therapies. However, it remains to be seen whether IU-related effects during threat extinction training are reliably and specifically driven by the IU construct or a particular subcomponent of the IU construct over other self-reported measures of anxiety. Methods: A meta-analysis of studies from different laboratories (18 experiments; sample N = 1006) was conducted on associations between different variants of self-reported IU (i.e., 27-item, 12-item, inhibitory, and prospective subscales), trait anxiety, and threat extinction training via skin conductance response. The specificity of IU and threat extinction training was assessed against measures of trait anxiety. Results: All the self-reported variants of IU, but not trait anxiety, were associated with threat extinction training via skin conductance response (i.e., continued responding to the old threat cue). Specificity was observed for the majority of self-reported variants of IU over trait anxiety. Conclusions: The findings suggest that the IU construct broadly accounts for difficulties in threat extinction training and is specific over other measures of self-reported anxiety. These findings demonstrate the robustness and specificity of IU-related effects during threat extinction training and highlight potential opportunities for translational work to target uncertainty in therapies that rely on threat extinction principles such as exposure therapy.

The Effect of Anonymous Computer-Mediated Communication on State Anxiety: An Experimental Study.

This study examined the effect of anonymous computer-mediated communication (CMC) on state anxiety, specifically focusing on whether the valence of the interaction affected state anxiety before completing an anxiety-inducing task. Sixty-two female participants aged 18-25 were randomly assigned to one of three conditions: positive CMC, negative CMC, and blog. Self-report measures of state anxiety were taken at baseline; after participants had been given instructions about the anxiety-inducing task; after 10 minutes of CMC/blog writing; and after the anxiety-inducing task had been completed. Results showed that participants in the positive CMC condition showed a significant and moderate decrease in anxiety following the CMC, whereas those in the negative CMC condition showed a nonsignificant but moderate increase in anxiety following the CMC. Anxiety remained relatively unaffected by the blog condition. After completing the anxiety-inducing task, there were no differences in anxiety scores between groups. The findings show that CMC can be beneficial for relieving state anxiety, but the valence of the communication is crucial. This has implications for advice and training given to those participating in and supporting CMC where mental health issues might be discussed.

How many times do I need to see to believe? The impact of intolerance of uncertainty and exposure experience on safety-learning and retention in young adults.

Individuals who score high in self-reported Intolerance of Uncertainty (IU) display difficulties updating threat associations to safe associations. Here we sought to determine whether individuals who score high in IU can learn and retain new safety associations if given more exposure. We recorded skin conductance response, pupil dilation and expectancy ratings during an associative threat learning task with acquisition, same-day extinction and next-day extinction phases. Participants (n = 144) were assigned to either a regular exposure (32 trials of same-day and next-day extinction) or extended exposure condition (48 trials of same-day and next-day extinction). We failed to replicate previous work showing that IU is associated with poorer safety-learning indexed via SCR. We found preliminary evidence for promoted safety-retention in individuals with higher Inhibitory IU in the extended exposure condition, relative to individuals with higher Inhibitory IU in the regular exposure condition, indexed via SCR. These findings further our current understanding of the role of IU in safety-learning and -retention, informing models of IU and exposure-based treatments.

Selective extinction through cognitive evaluation: Linking emotion regulation and extinction.

The extinction of a previously conditioned response can be modulated through cognitive processes, including feature-based information, and explicit instruction. Here, we introduce a selective extinction through cognitive evaluation (SECE) task in which information is cognitively evaluated on a trial-by-trial basis to ascertain the extinction contingencies. Participants were conditioned to expect an electric shock during the presentation of one of two letters (CS+/CS-). During the SECE task, the letters were presented within words belonging to two categories, one of which indicated safety (COG-_CS+ trials), while risk of shock was maintained for the other category (COG+_CS+ trials). Skin conductance responses indicated that participants reduced their response to COG-_CS+ trials compared to COG+_CS+ trials. Clusters in bilateral insula and anterior cingulate cortex showed activation for COG+_CS+ trials that was reduced for COG-_CS+ trials. A network of brain regions, including left inferior frontal gyrus, and bilateral temporal and parietal cortices showed greater activation for COG-_CS+ versus COG+_CS+ trials. This is consistent with the semantic processing and decision-making necessary to evaluate the trial contingencies. We compared activation in the SECE task to activation in a cognitive reappraisal task in which participants were asked to attend to, or regulate their emotional reactions to affective IAPS images. This task replicated prefrontal activation seen in previous reappraisal studies. A voxelwise conjunction analysis found no overlap between the cognitive reappraisal and the SECE task, but we did find evidence for common activation in follow-up ROI analyses, supporting the idea of common lateral prefrontal mechanisms involved in both processes.